The mother of a 2-year-old tells you she is constantly scolding him for having wet pants. She says her son was trained at 12 months, but since he started to walk, he wets all the time. Which nursing diagnosis would be most applicable?
A) Deficient parental knowledge related to inappropriate method for toilet training
B) Excess fluid volume related to inability to control urination
C) Ineffective coping related to lack of self-control of 2-year old
D) Total urinary incontinence related to delayed toilet training
A
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After administering a CNS stimulant to a client being treated for respiratory depression, the nurse would continue to assess which of the following? Select all that apply
A) Blood pressure B) Pulse C) Respiratory rate D) Respiratory pattern E) Level of consciousness
The nurse is caring for a patient with an admitting diagnosis of congestive failure. While attempting to obtain a pulmonary artery occlusion pressure in the supine position, the patient becomes anxious and tachypneic
What is the best action by the nurse? a. Limit the patient's supine position to no more than 10 seconds. b. Administer anxiety medications while recording the pressure. c. Encourage the patient to take slow deep breaths while supine. d. Elevate the head of the bed 45 degrees while recording pressures.
A patient has been admitted to a unit at a primary stroke center after experiencing an ischemic stroke
The nurse on the unit is aware of the vital importance of rehabilitative efforts and knows that an active rehabilitation program should begin at what point? A) As soon as the patient is able to independently identify goals for rehabilitation B) As soon as moderate motor activity is regained on the affected side C) As soon as sensory ability is regained on the affected side D) As soon as the patient regains consciousness
A patient who complains frequently may be
A) fearful. B) angry with the staff. C) angry with you. D) mentally ill.